Question
How did American Indian youth who live on or near reservations experience the COVID-19 pandemic?
Findings
This cross-sectional study among 2559 American Indian students in grades 6 through 12 found that approximately 14% of the sample reported having had a test result positive for SARS-CoV-2 infection, a higher rate than for all cases nationally and for children nationally, and three-quarters of the sample reported someone close contracting COVID-19, while more than one-quarter reported someone close dying from COVID-19. Regarding perceived psychosocial impacts, COVID-19 was associated with strained friend relationships, lower school engagement, and less social connectedness, although more than 60% of students reported feeling no change or a decrease in negative emotions, such as sadness and anxiety.
Meaning
These findings suggest that although COVID-19 mortality and morbidity rates were high on American Indian reservations, psychosocial impacts were complex and many students were resilient in the face of the pandemic.
Importance
Impacts of COVID-19 on reservation-area American Indian youth are unknown and may be substantial owing to the significant COVID-19 morbidity and mortality experienced by American Indian populations.
Objective
To measure self-reported illness experiences and changes in psychosocial factors during the COVID-19 pandemic among reservation-area American Indian youth.
Design, Setting, and Participants
This cross-sectional study included a random sample of US schools on or near US Indian reservations during Spring 2021, stratified by region, with students in grades 6 to 12 completing cross-sectional online surveys. All enrolled self-identifying American Indian students in grades 6 to 12 attending the 20 participating schools were eligible to be surveyed; participants represented 60.4% of eligible students in these schools. Data were analyzed from January 5 to July 15, 2022.
Exposures
Onset of the COVID-19 pandemic.
Main Outcomes and Measures
Outcomes of interest were COVID-19 self-reported illness outcomes for self and family and close friends; perceived changes in family and friend relationships, school engagement, social isolation, and other psychological factors since the COVID-19 pandemic began; and worry over COVID-19–related health outcomes.
Results
A total of 2559 American Indian students (1201 [46.9%] male; 1284 [50.2%] female; 70 [2.7%] another gender; mean [SD] 14.7 [8.9] years) were included in the analysis. Approximately 14% of the sample reported having had a test result positive for SARS-CoV-2 infection (14.3% [95% CI, 11.4%-17.6%]), a higher rate than for all cases nationally at the time of the survey. Regarding prevalence of COVID-19 among family and close friends, 75.4% (95% CI, 68.8%-80.9%) of participants reported having at least 1 family member or friend who had contracted COVID-19, while 27.9% (95% CI, 18.8%-39.3%) of participants reported that at least 1 family member or close friend had died of COVID-19. Regarding psychosocial impacts, COVID-19 was associated with strained friend relationships (eg, 34.0% [95% CI, 28.4%-40.0%] of students reported worry over losing friends), lower school engagement, and less social connectedness (eg, 62.2% [95% CI, 56.7%-67.4%] of students reported feeling less socially connected to people), although more than 60% of students also reported feeling no change or a decrease in negative emotions. Males were less likely to report perceived negative impacts, especially for negative emotions such as sadness (29.2% [95% CI, 23.3%-35.9%] of males vs 46.1% [95% CI, 43.9%-48.3%] of females reported feeling more sad) and anxiety (21.8% [95% CI, 18.2%-25.8%] of males vs 39.2% [95% CI, 34.1%-44.6%] of females reported feeling more anxious).
Conclusions and Relevance
This cross-sectional study provides novel insight into the perceived experiences of reservation-area American Indian youth, a population at uniquely elevated risk of poor health status and health care access, during the COVID-19 pandemic. Although mortality and morbidity rates from COVID-19 were high on American Indian reservations, student reports of psychosocial impacts were complex and suggest many students were resilient in the face of the pandemic. These findings could be used to understand and address the challenges facing American Indian youth due to the pandemic and to guide future research that examines the factors and processes associated with the reported outcomes.